It is estimated that about 10% of adult patients with foot problems suffer form plantar fasciitis. It is a common disease for runners and other athletes and occurs often in persons over 40 years of age. The diagnosis and treatment of this musculoskeletal condition were analyzed by Buchbinder.
It is estimated that about 10% of adult patients with foot problems suffer form plantar fasciitis. It is a common disease for runners and other athletes and occurs often in persons over 40 years of age. The diagnosis and treatment of this musculoskeletal condition were analyzed by Buchbinder.
Plantar fasciitis patients suffer from chronic inflammatory changes at the site of origin of the plantar fascia on the medial tuberosity of the calcaneus. Repetitive microtrauma to the fascia can be caused by various conditions connected with plantar fasciitis, including obesity, long-distance running, excessive pronation (pes planus), and decreased ankle dorsiflexion. Plantar fasciitis is inclined to be self-limited, and research has discovered that symptoms resolve in most patients within one year. According to the author, even surgical case series, report surgical intervention rates of only about 5 percent.
In most cases the diagnosis of plantar fasciitis is obvious and easy. Patients usually observe the slow outbreak of inferior heel pain, which often is worse in the morning and increases during the day after prolonged weight-bearing activities.
To demonstrate increased plantar fascia thickness in patients ultrasonography and magnetic resonance imaging have been used. Imaging is usually not neededy for diagnosis. Plain radiography and bone scans may be used to detect calcaneal stress fracture. The presence of calcaneal bone spurs on plain radiographs is worthless to make or exclude the diagnosis of plantar fasciitis.
There is a wide range of treatment methods for plantar fasciitis. However, many of them are ineffective. Calf muscle stretching, plantar fascia stretching, and foot taping are widely used, however, there are no data to prove their effectiveness. Magnetic insoles, therapeutic ultrasonography, laser therapy, iontophoresis, or electron-generating devices have no demonstrated benefit. Heel cups, pads, and orthotics are also used in the treatment, but evidence of efficacy is limited and sometimes contradictory. And so is the use of night splints to hold the heel in a neutral position or some dorsiflexion.
Injection of corticosteroids near the plantar fascia origin provides short-term pain relief. The author points out a limited role for surgery in selected patients with refractory symptoms after 6 to 12 months of traditional therapy. The quicker recovery time is reported after endoscopic surgical approaches to fascia release, in comparison with the usual open procedures. But such treatment may result in higher risk of nerve injury.
